Effect of morphine on breathlessness and exercise endurance in advanced COPD: a randomised crossover trial. Issue 4 (19th October 2017)

• Record Type: Journal Article
• Authors: Abdallah, Sara J.; Wilkinson-Maitland, Courtney; Saad, Nathalie; Li, Pei Zhi; Smith, Benjamin M.; Bourbeau, Jean; Jensen, Dennis
• Is Part Of: European respiratory journal. Volume 50:Issue 4(2017)
• Publication Date: 2017-10-19
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01235-2017
• Languages: English
• ISSNs: 0903-1936

Abstract

The objective of the present study was to evaluate the effect of morphine on exertional breathlessness and exercise endurance in advanced chronic obstructive pulmonary disease (COPD). In a randomised crossover trial, we compared the acute effect of immediate-release oral morphine versus placebo on physiological and perceptual responses during constant-load cardiopulmonary cycle exercise testing (CPET) in 20 adults with advanced COPD and chronic breathlessness syndrome. Compared with placebo, morphine reduced exertional breathlessness at isotime by 1.2±0.4 Borg units and increased exercise endurance time by 2.5±0.9 min (both p≤0.014). During exercise at isotime, morphine decreased ventilation by 1.3±0.5 L·min −1 and breathing frequency by 2.0±0.9 breaths·min −1 (both p≤0.041). Compared with placebo, morphine decreased exertional breathlessness at isotime by ≥1 Borg unit in 11 participants (responders) and by <1 Borg unit in nine participants (non-responders). Baseline participant characteristics, including pulmonary function and cardiorespiratory fitness, were similar between responders and non-responders. A higher percentage of responders versus non-responders stopped incremental CPET due to intolerable breathlessness: 82 versus 33% (p=0.028). Immediate-release oral morphine improved exertional breathlessness and exercise endurance in some, but not all, adults with advanced COPD. The locus of symptom-limitation on laboratory-based CPET may help to identify patients most likely to benefit from morphine. Immediate-release oral morphine decreased exertional breathlessness and improved exercise endurance in advanced COPD http://ow.ly/mrHQ30dS2qS